Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 5201011125 | MI |
NPI | 1043898737 |
---|---|
Provider Name | Melissa Junkulis |
First Address | Saint Clair Shores, MI 48082-1732 |
Second Address | Saint Clair Shores, MI 48082-1732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2021 |
Last Update Date | 01/04/2021 |